The Labour government has opened a new front in its assault on the working class, with dire consequences for many of the people who hold Britain’s overstretched health and social care services together.

On November 20, Labour Home Secretary Shabana Mahmood unveiled a proposed brutal restructuring of immigration rules under the Orwellian title “A fairer pathway to settlement.” The measures are in fact designed to trap migrant workers in a state of prolonged insecurity.

The message could not be clearer: work, pay taxes, fill the gaps left by a collapsing system, but do not expect permanent rights, stability or family life in return. It marks a decisive escalation of Labour’s nationalist, anti-immigrant agenda which mirrors that of right-wing and far-right governments across Europe and the United States.

Mahmood’s proposals on migrants—along with her earlier Restoring Order and Control attack on asylum seekers—could just as easily have been issued under the far-right Reform UK party’s letterhead. Taken together they effectively abolish the right to asylum and extend the residency period required for Indefinite Leave to Remain (ILR) and citizenship, laying the legal groundwork for mass deportations.

Under the new system, most migrant workers—including health and social care staff—must live in Britain for 10–15 years before applying for ILR, instead of the current five. If they claim welfare benefits for under a year it becomes 15 years; claim for longer and it rises to 20. Anyone entering the UK through an unsanctioned route could wait 30 years for permanent status.

Even gaining the right to ILR may not secure basic support. Mahmood has suggested tying welfare eligibility not to ILR but to full citizenship—meaning decades of work, taxes and service could still end in second-class status.

The public “consultation”, set to end in February next year, will take place in a toxic climate towards migrants carefully manufactured with the help of the corporate media. Implementation is due in April, and the legal, ideological and administrative groundwork is already in place.

English-language requirements will be raised to A-level, alongside higher salary thresholds and financial checks that penalise debt, irregular income or hardship. One period of illness, a pregnancy, or a rent hike pushing someone into temporary debt—and the clock resets.

The aim is to establish a permanently insecure workforce using citizenship, salary and passport exceptions to divide workers whose employment in the UK reflects the international character of the working class itself. The class bias on migration could not be starker with the wealthy able to glide through comparatively easily: high-earners and “entrepreneurs” earning over £125,140 can obtain ILR in just three years.

The infamous “hostile environment” pioneered by the Tories pales in comparison. So vicious is Labour’s policy that the Royal College of Nursing (RCN) warned ahead of the announcement that up to 50,000 migrant nurses could leave the UK under the restrictions.

In a calculated act of political self-preservation, Mahmood ultimately exempted NHS nurses, doctors and teachers from her crackdown—health workers whose roles are highly visible and elicit strong public sympathy. However, private-sector nurses, healthcare assistants, residential care staff, support workers and agency carers—who play a critical role in Britain’s care system—are still in the firing line.

Speaking before Mahmood’s belated announcement exempting NHS nurses from the dragnet, but pointing to the situation which still confronts many others, a migrant nurse at University Hospitals Dorset told the World Socialist Web Site: “I feel very disappointed and discouraged by this plan. Doubling ILR from five to 10 years turns, what is already a demanding process into something that feels endless and insecure.

“ILR isn’t a reward—it’s the basic stability needed to build a life, and stretching the timeline feels punitive. It would mean many more years of visa renewals, high fees and constant work. Instead of being settled, we remain temporary and unsafe.”

“The NHS is already struggling with staff shortage. If settlement becomes harder, many may not come—or will leave for countries with clearer routes. That means worsening shortages, more pressure on staff, longer waiting times and real risks to patient safety.”

A migrant doctor who works as a care assistant in supported living and has lived here more than three years told the WSWS: “The Labour Party is irresponsibly responding to [Reform UK leader] Nigel Farage’s policies against migrants. This affects all skilled workers in Britain waiting for ILR, people who came here giving up jobs, money and properties, hoping for a better future.”

“With this decision people will be helpless and clueless about their future. It affects them physically and emotionally, leading many to be depressed. People will have second thoughts about coming here. This will lead to a collapse of the health and social care system.”

He added, “I have done all the necessary exams to practise as a doctor here, but it is very difficult to find a job in the NHS… I’m worried that even if I succeed, I will have to stay much longer to get ILR.”

This assault comes when the social care system is on the brink. Britain has 130,000 care vacancies and two million elderly people are living with unmet care needs.

Hospitals discharges of many medically fit patients—who require a carer—are routinely delayed because not enough carers exist to support them at home, adding to the NHS gridlock. Patients routinely wait on trolleys in corridors, ambulances queue at A&E bays, and wards overflow.

There is no serious opposition in Westminster to the anti-migrant crusade and its consequences, only competition over which party who can penalise them more efficiently.

Mahmood’s draconian measures were claimed by the Conservative opposition as their own, with shadow Home Secretary Chris Philp stating, “There is much in this statement that I support. I am delighted to see the Home Secretary got out her laptop and started copying and pasting Conservative policies.”

As for the trade union leaders in the sector, they have responded only with statements of concern, moral indignation and sternly worded press releases. Unison called the proposals “devastating”, the RCN a “betrayal”. But the union bureaucracy proposes nothing practically beyond appeals to the very government carrying out the assault.

Their role is not to lead resistance but to contain and divert it into the safe, harmless channels of “consultation” and parliamentary debate. The bureaucracy performed the same function during the NHS strike wave in 2022-3, dispersing the movement into fragmented, limited stoppages before helping shut them down and foist de facto pay cuts on their members.

The defence of migrant health and care workers cannot be entrusted to the union partners of the Labour Party. It must be led from below by rank-and-file health and care workers organising independently of the union bureaucracy, linking migrant and non-migrant staff, uniting NHS and private-sector carers, demanding rights not as privileges but as inalienable.

• For the unity of all NHS staff—health workers, cleaners, porters and support workers!
• Full rights for all workers—citizenship, family unity, and equal access to services!
• Fund health and social care not tax concessions to big business and military expenditure for war!

This is the perspective advanced by NHS FightBack in opposition to the Starmer government’s hostile environment and its complicit allies in the trade union bureaucracy.